1. Automatic External Defibrillation Aaron J. Katz, AEMT-P, CIC www.es26medic.net

2. AHA Chain of Survival Early access Early CPR Early defibrillation Early ALS

4. Cardiac electrophysiology SA Node “dominant pacemaker” “Fires” 60-100 times per minute Internodal pathways AV Node Bundle of HIS Left and right bundle branches Purkinje network

5. Nonperfusing heart rhythms Ventricular tachycardia (“VTACH”) Ventricular fibrillation (“VFIB”) Asystole Electromechanical dissociation (EMD) Pulseless electrical activity (PEA)

6. VTACH

7. VFIB

8. Asystole

9. The bottom line All the above abnormal heart rhythms can not produce a perfusing pulse Pulseless VTACH and VFIB CAN be successfully converted to a perfusing rhythm using a defibrillator

10. AED – the technology Very accurate computer enabling recognition of lethal rhythms (“Analyze”) Modern AED will talk Shocking mechanism (“Shock”) Automatic vs. semiautomatic

11. Common AED errors Bad battery Patient moving AED applied to a responsive patient

12. Bad battery Use fully charged batteries Depends on manufacturer Pay attention to AED warnings about batteries Bad batteries are uncommon today COLD WEATHER

13. Patient moving Causes inaccurate analysis Don’t touch the patient Stop the bus when analyzing!

14. AED applied to a responsive patient AED applied to a responsive patient with a rapid pulse AED may falsely interpret as VTACH – and recommend shock Therefore: only apply AED to an unresponsive pulseless patient

15. Complications & solutions Patient has a pacemaker Apply pads 5” from pacemaker AICD No danger to EMT! Small amount of energy Apply pads 5” from pacemaker Very hairy chest Shave the area Keep a disposable razor with your defibrillator

16. Integrating AED into CPR

17. AED integration Arrive at the scene Assess responsiveness Stop CPR (EMTs or bystanders) Verify pulselessness & apnea Resume CPR until AED is ready

18. *** NOTE WELL *** If you are the only rescuer, DO NOT DO CPR UNTIL THE PATIENT IS DEFIBRILLATED The most important life saving action for the cardiac arrest patient is defibrillation Therefore, PREPARE THE DEFIBRILLATOR!

19. AED integration – cont’d Prepare for defibrillation: Bare the chest Power on AED Remove nitro paste/patches Apply pads to the chest Look at the pads, they show you how Right: right of sternum under clavicle Left: left ribs Top of pad should 2-3” below armpit Apply them smoothly STOP CPR

20. AED integration – cont’d Make sure no one is touching the patient Either press analyze or “Analyze” may start on its own AED may tell you “analyzing – do not touch the patient” Results…

21. AED integration – cont’d Analysis at any time will result in either: Shock advised AED will charge and tell you to clear the patient and press shock First shock within 90 seconds of AED availability No shock advised Patient may have a pulse Patient has a nonshockable rhythm Asystole, EMD/PEA

22. Shocks recommended Initial analyze/shock up to 3 times Three “stacked analyze/shocks” Check pulse… Pulse absent? CPR for one minute check pulse, no pulse? Three stacked analyze/shocks We’re now up to 6 shocks Check pulse

23. Decision time Short transport time? Transport Continue CPR Long transport time/ALS close? 3 stacked analyze/shocks 1 minute CPR Check pulse Repeat sequence until hospital or until No Shock Advised

24. No shock advised CPR Transport

25. Pulse Present? Assess Vital Signs Support ABCs Immediate Transport

26. AED and Children Do not use the AED in pediatric cardiac arrest unless: AED is equipped for and FDA approved for use on children less than 8 years of age

27. Hypothermic patients & AED Limit shocks to 3 After 3 shocks, if needed, CPR, rewarming and transport